St Peter's Hospital

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The maternity service had had several senior leadership changes, and this had led to some staff feeling unsettled. The Director of Midwifery and the Head of Midwifery had only been in post for 5 months.

There was a new maternity strategy in place and an ongoing review of the trust’s maternity services. This had led to several new processes being embedded into the service to drive sustainability and improvements in care.

We found there had been several changes made within the service and not all staff had felt changes were communicated well from the senior leadership team to the ground floor. However, other staff had seen recent developments and changes as a positive step to improve the maternity service.

At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to ‘Good’.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of women and birthing people and their communities. However, there were mixed views on the culture within the service.

The Director of Midwifery and the Head of Midwifery had been in post for 5 months. They both had a shared vision, strategy and culture of what they would like the maternity service to achieve.

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The maternity strategy developed in 2024 had four key objectives, which focused on listening to and working with women and birthing people and families, growing, retaining and supporting their workforce, developing and sustaining a culture of safety and developing standards and structures to develop personalised care.

The strategy and ongoing review of the trust's maternity services had led to several new processes which were being embedded into the service. The senior leadership team had a focus on many areas to drive sustainability and improvements in care.

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The service worked alongside the Local Maternity and Neonatal System (LMNS), Maternity Voices Partnership and Maternity and Newborn Safety Investigations (MNSI) programme in addition to other services to better respond to the needs of the local population.

We found there was a clear divide regarding staff morale within the service. Several staff told us they felt tired and ‘burned out'. Not all staff were happy with the current changes taking place within the maternity service, regarding the reduction in bank and agency staffing usage and changes proposed to the band 7 co-ordinator role. This meant some staff felt anxious and unsure of the direction the maternity service was taking. Whilst other staff felt there was a need for change and welcomed the changes.

There were mixed feelings about the culture within the service. Some staff felt there was a positive culture, some staff told us they felt burnt out and tired. There was a sense of staff being concerned about changes within their role. However, other maternity staff saw the developments and changes as a positive step to improve the service.

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The service had introduced a perinatal culture plan with a focus on supporting staff to feel included within the maternity team and staff told us there were good relationships between midwifery and obstetric staff.

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The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Most staff told us they were able to speak with the ward managers and matrons about concerns or personal issues. Staff spoke with colleagues and ward managers when involved in incidents and felt supported by senior leaders.

Within the last 6 months the maternity service had recruited into their senior leadership posts and there was now a clear developed leadership structure. The Director of Midwifery (DOM) was under the divisional director for Women’s Health and Paediatrics.

The director of midwifery worked alongside the interim head of nursing, paediatrics and neonates. The head of midwifery worked directly under the DOM and oversaw the midwifery senior leads and matrons.

The senior leadership had previously experienced numerous changes, with several interim roles. This meant there has not been clear plans for maternity leadership.

Previously there had been maternity staffing which did not meet the expected templates/safety standards and a lack of effective systems and processes to assess, monitor and improve the quality and safety of maternity services. Since our last inspection there had been a clear focus to improve services and to recruit permanent senior positions into the maternity service.

The service promoted equality and diversity in daily work and provided opportunities for career development with the development of senior midwifery roles.

Not all staff we spoke to, felt the service fostered a positive culture, where they felt they could speak up and their voice would be heard.

Staff and leaders were currently in a process of change to drive improvement. Not all staff we spoke to felt positive about the rapid changes to the service and some staff felt they were unable to raise their concerns or make a complaint.

The trust provided a raising concerns inbox for staff to raise concerns related to their work and we saw evidence of this shared on the maternity newsletter

We observed evidence where managers had investigated complaints, identified themes and shared feedback with staff. Learning from these was used to improve the service and was visible on boards around the maternity unit.

The service had a maternity freedom to speak up guardian who was available to all maternity staff and there was a ‘We follow the trust Freedom to Speak Up: Raising Concerns (whistleblowing)’ policy.

There were processes in place, and staff were aware of the Freedom to Speak Up Guardian (FTSUG) in the trust. Some staff had used the option to escalate their concerns. The Executive and Non-Executive Safety Champions undertook regular drop-in listening events. A divisional action plan based on formal feedback from staff surveys was monitored through safety champion meetings and the trusts Quality of Care Committee.

The service valued diversity in their workforce. Staff worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff and leaders told us the service promoted equality and diversity within their daily work. The service had an equality, diversity and inclusion policy and an equality, diversity and inclusion’ lead midwife.

The service implemented practice development programmes for each staffing group. For example, there was a specific maternity support worker developmental programme as well as development programmes for different levels of seniority of staff.

High dependency care courses were available for all band 7 labour ward shift leaders, maternity operational co-ordinators and complex care team midwives. The service had introduced an advanced midwifery practitioner (AMP) and the role was to support Triage and Day assessment Unit and coordinate any patient deterioration situations.

The service offered equality and diversity and inclusion (EDI) online training as part of their mandatory package.

The service had improved its oversight and was acting on information of risk, performance and outcomes. The service had clear responsibilities, roles and systems of accountability and there had been work completed to improve the reporting of incidents.

The service had a governance structure that supported the flow of information from frontline staff to senior managers and to the trust board. A monthly risk review group was in place to identify and monitor risks using the divisional risk register.

Following the previous assessment, the service had not completed all actions related to separating the maternity and corporate risk register to ensure better oversight of maternity risks. However, outstanding maternity risks were escalated to the board to provide clear oversight of risks within the maternity service.

Monthly governance meetings were held to discuss incidents, identify themes and learning, and actions to reduce future occurrences. The maternity and neonatal assurance group met monthly to review and monitor incident investigations in addition to the monthly governance meetings.

The maternity and neonatal governance group meetings received assurance that governance arrangements were in place to monitor the completion of action plans and the subsequent effectiveness of risk reduction measures.

There was a quarterly triangulation approach in reviewing incidents and complaints to prioritise themes.

Maternity safety champions held regular quarterly meetings with a set agenda. We were told actions from previous meetings were reviewed, as well as any quality improvement projects. The service shared the Maternity Safety Champion Director of Midwifery and Non-Executive Directors Walk Around schedule for 2025. Feedback from the walk arounds were shared during Maternity Safety Champion meetings.

Leaders monitored key safety and performance metrics. They identified and escalated relevant risks and issues and identified actions to reduce their impact. An audit programme was in place to provide assurance of the quality and safety of the service.

There was a discrepancy in the methodology the trust was using to measure compliance with cardiotocography (CTG) monitoring and ‘fresh eyes’. This showed an inaccurate low staff compliance in completing ‘fresh eyes’. As a result, the trust introduced a second paper-based method which showed improved compliance with hourly ‘fresh eyes’ reviews, although this remained below the trust target. In recognition of the need to drive improvement the trust put in place an action plan which showed better oversight of monitoring and an improvement in compliance.

Staff understood their roles and responsibilities and the maternity team had regular opportunities to meet, discuss and learn from the performance of the service.

Staff were encouraged to report incidents. Staff knew how to raise and report an incident. Staff received feedback on an incident if they had requested further information. Leaders identified and escalated relevant risks and issues and identified actions to reduce their impact. Risks were identified through Quality and Safety within the monthly risk and governance meetings. The leadership team took action to make changes where risks were identified.

The service mostly understood their duty to collaborate and work in partnership, so services work seamlessly for women and birthing people. Staff shared information and learning with partners and collaborate for improvement

Service leaders attended regular meetings with the Local Maternity Network System (LMNS) to review governance and incidents. The perinatal governance team attended the Quality and Safety Forum with the LMNS where quarterly governance risk reports were reviewed

The patient experience midwife liaised with women, birthing people and local communities to talk about their maternity experiences and to identify key themes from feedback. To ensure user collaboration and feedback the patient experience midwife and the maternity and neonatal voice partnership (MNVP) set up a working group to encourage service user involvement to review feedback and service ideas to improve services for women and birthing people. For example, the group reviewed the printed materials and information videos on infant feeding. There were plans to expand community engagement to complete focus groups within family centres to reach women, birthing people and families that may not usually engage with the service.

The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for women and birthing people. Staff actively contribute to safe, effective practice and research.

Staff and leaders had a good understanding of how to make improvement happen. They were committed to continually learning and improving services. There was an understanding of quality improvement methods and the skills to use them.

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The service was proactive in supporting staff to develop and improve recruitment and retention. There was a monthly `Careers Café' organised by the workforce and development midwife and all maternity staff were invited to attend. This included domestic, admin, maternity support workers, students and midwives.

There were specific sessions arranged to support the development of midwives. For example, there were `This midwife can' sessions in place to support midwives in gaining confidence in skills. For example, perineal suturing and cannulation.

All Band 7 midwives attended a manager's toolkit training, which supported midwives to gain several different management skills. These sessions included how to recruit, motivating and engaging others, enabling quality improvement and innovation.

There was ongoing work on the postnatal ward to support midwifery students, under the guidance of a midwife, to assess and review the ongoing care for women and birthing people. This was to support students' confidence and to build their knowledge.

There were several quality improvements (QI) taking place. The maternity and neonatal team had completed a comparison of a thermoregulated incubator for babies compared with a standard incubator for the maintenance of thermal stability in preterm infants with user feedback. Following the quality improvement the service planned for maternity and neonatal staff to be trained on using the incubator for transfer, and a standard operating procedure for transfer would be put in place.

The service had introduced a Preterm Birth Clinic to improve the numbers of women and birthing people giving birth prematurely. The work was part of a National Maternity Safety Ambition to reduce the national rate of preterm births from 8% to 6%. St Peter's Hospital showed they had significantly reduced the percentage of preterm birth rates in 2023, with the rate being 5.8% compared to 8% nationally for the number of babies born below 37 weeks. The work and multidisciplinary approach used had been recognised nationally and leaders/staff had presented the work to the Local Maternity and Neonatal Systems and maternity network events.

The postnatal transformation project was initiated in response to providing a better focus within postnatal care. The key areas for improvement for postnatal care were around discharge delays and visiting policies. Following on from the project, the postnatal ward increased visiting hours and partners were now able to stay overnight. There was also the introduction of the seven-day discharge coordinator role and since the introduction there was a noticeable improvement in discharge delays when the discharge coordinator was present. This had led to a permanent request for funding for the role.

The labour and postnatal ward were working together on a quality improvement project to improve the efficiency of transfer of women, birthing people and babies from the labour ward to postnatal ward. This would be a review of feeding, management plan and risk assessments prior to transfer and is reviewed and signed off by the team leader on labour ward.

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